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Post-operative Instructions

Follow these instructions closely after your surgery or procedure.

Post-operative instructions for ACL reconstruction

Rest, Ice and Elevation

  • Elevate your knee under heel not the knee to prevent flexion contracture or stiffness in the knee.
  • The Cold Therapy unit is helpful in reducing swelling, minimizing requirements for narcotics and accelerating return to normal knee function.
  •  Follow instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day.  Continuous use is allowed and encouraged, if not uncomfortable.
  • Keep knee’s dressing dry.  Do not remove it.  Small amount of bloody drainage on the dressing is not unusual and this can be covered with a clean 4X4 gauze and ACE wrap.

 Crutches

  • Your brace is to be worn at all times.  You will be told if weight bearing on the operated leg is allowed.
  • Crutches may be helpful for the first several days.  Discontinue use of crutches per your doctor’s instructions.  The brace is to be locked in full extension (0 degrees) when not in the CPM machine.
  • A Continuous Passive Motion machine (CPM) is designated to aid in regarding knee motion and promote graft healing.  Regaining your motion may take many weeks.  Using the CPM should not cause excessive pain or bleeding.  Decrease the motion if excessive pain or bleeding occurs.
  • You will be told what settings to use on the CPM machine. On the day after surgery you will start between 0 and 60 degrees. You will be told the total number of hours and how much are in the morning and how much are in the afternoon.

Exercise

  • Begin exercises the night of surgery.  Repeat 10 times every hour.
  • Quad sets: Push the back of the knee into bed and hold for the count of 10.
  • Straight leg raises (SLR): lift leg in knee brace off the bed for count of 10.
  • Ankle pumps: Push ankle up and down multiple times to encourage blood flow in leg.
  • Hamstring sets: Push heel into bed for count of 10.
  • buttock by pulling your knee to your chest when you slide.

Medication

  • You will be told which medications to take.
  • To minimize gastric upset from narcotics or anti-inflammatory medication, eat adequate amounts of food.  Increase fluid and fiber intake to ease constipation from pain medication.
  • Take your pain medication as prescribed for the first 3-4 days.

Questions/Concerns

Your surgeon should be contacted by calling 703-810-5202 Option 3, 24 hours a day for any of the following symptoms:

  • Fever greater than 101.5 degrees F for 24 hours. 
  • Redness or swelling in the calf that doesn’t resolve overnight.
  • Numbness, loss of good color or coolness in the foot. 
  • Severe pain unresponsive to narcotic medication.
  • Excessive bleeding or vomiting.
  • Difficulty breathing or shortness of breath, CALL 911

Follow-Up

Your follow-up appointment will be scheduled when your surgery is scheduled. If you need to verify or change your post-op appointment, please call 703-277-2663.

Post-operative instructions for knee arthroscopy

Rest, Ice and Elevation

  • Elevate your knee and apply an ice pack to help reduce pain and swelling for 24 hours.
  • Keep the dressing and incisions dry at all times.
  • Small amounts of drainage on the dressing are normal and may be reinforced with a 4×4 gauze and Ace wrap.
  • You may bend your knee as much as the dressing allows.

Crutches

  • Use cane or crutches for security and comfort as needed.  Discard them as soon as possible unless otherwise specified by your doctor.
  • You will be told if weight bearing is allowed as tolerated with pain and swelling being your guide to activities.

Exercise

No sports, running, excessive stair climbing, squatting, or jumping. If your job requires little physical activity, you may return to work in two to three days.  If your job requires considerable standing, lifting, walking or climbing, discuss your return to work date with the surgeon.

  • Begin exercises as soon as possible. Do 10 sets every hour up to 100 per day.
  • Quad Sets – Straighten your knee, tense the quad muscle, hold for 5 seconds, and then relax for 5  seconds.
  • Straight Leg Raises – Tightening your thigh muscle and lift your leg approximately 24 inches, hold for 5 seconds. Then slowly lower your leg keeping your leg straight and thigh muscle tight.
  • Ankle Pumps – Push your ankle up and down to promote blood flow.
  • Heel slides– Sit on a firm surface with your leg straight in front of you.  Slowly slide the heel of your operative leg toward your buttock by pulling your knee to your chest when you slide.

Medication

  • You will be told which medications to take.

Dressing/Showering

  • Remove the dressing 48 hours after surgery. Leave the steri-strips intact.
  •  Clean the extremity with rubbing alcohol to remove the surgical prep solution.  You may shower at this point, no baths, hot tubs, or swimming.  Prior to showering, cover the knee with plastic wrap to keep the knee dry.
  •  If the knee gets wet, dry immediately.  After the shower cover the incisions with band-aids.  Change the band-aids daily.

Questions/Concerns

Your surgeon should be contacted by calling 703-810-5202 Option 3, 24 hours a day for any of the following symptoms:

  • Fever greater than 101.5 degrees F.
  • Redness or swelling in the calf that doesn’t resolve overnight.
  • Numbness, loss of good color or coolness in the foot.
  • Severe pain unresponsive to narcotic medication.
  • Excessive bleeding or vomiting.
  • Difficulty breathing or shortness of breath, CALL 911.

Follow-Up

Your follow-up appointment will be scheduled when your surgery is scheduled. If you need to verify or change your post-op appointment, please call 703-277-2663.

Post-operative instructions for shoulder arthroscopy

You will receive your customized post-op instructions after your surgery.

Rest, Ice and Elevation

  • Lying flat in bed will be uncomfortable for several days.
  • Sleeping in a recliner or with your back elevated on several pillows can be helpful.
  • Apply ice to the shoulder intermittently for the first 24 hours.

Exercise

  • Wear the sling for protection post-operative.
  • Keep the sling in place until your surgeon sees you in the office.
  • Starting tomorrow you may remove the sling 3-4 times a day to allow elbow, wrist and hand motion.
  • Also begin gentle circular movements and pendulum exercises

Medication

  • You will be told which medications to take.
  • To minimize gastric upset from narcotics or anti-inflammatory medicine, eat adequate amounts of food.
  • Increase fluid and fiber intake to ease constipation from pain medication.

Dressing/showering

________ Slight bleeding through the dressing is common.  Excessive bleeding should be reported to your surgeon.  Dressings must be kept dry.  Modify your bathing appropriately.  Swimming or hot tubs are not allowed until the wound is completely healed.  Use rubbing alcohol to remove the betadine prep solution from your skin.
_________ Remove the dressing in 72 hours.  Apply band-aids to incision sites and then you may shower.  Avoid direct water on the dressing or incision site.  Reapply band-aids after showering.

Question/concerns

Your surgeon should be contacted by calling 703-810-5202 Option 3, 24 hours a day for any of the following symptoms:

  • Fever greater than 101.5 degrees F.
  • Numbness, loss of good color or coolness in the arm.
  • Severe pain unresponsive to narcotic medication.
  • Excessive bleeding or vomiting.
  • Difficulty breathing or shortness of breath, CALL 911.

Follow-Up

Your follow-up appointment will be scheduled when your surgery is scheduled. If you need to verify or change your post-op appointment, please call 703-277-2663.

Post-operative instructions for upper extremity

Rest, Ice and Elevation

  • Lying flat in bed will be uncomfortable for several days.
  • Sleeping with your back elevated on several pillows can be helpful.
  • Apply ice to the shoulder intermittently for the first 24 hours.

Exercise

You will be told to follow ONE of these two options.

  • Wear the sling for protection post-operatively. Keep the sling in place until your surgeon sees you in the office. Starting tomorrow you may remove the sling 3-4 times a day to allow elbow, wrist and hand motion. Also begin gentle circular movements and pendulum exercises.
  • Tomorrow remove the sling and begin gentle motion exercises. Discard sling as soon as comfortable. In 3-4 days begin wall climbing exercises and gradual overhead stretches.

Medication

You will be told which medications to take.

Dressing/Showering

  • Slight bleeding through the dressing is common. Excessive bleeding should be reported to your surgeon. Dressings must be kept dry. Modify your bathing appropriately. Swimming and hot tubs are not allowed until the wound is completely healed. Use rubbing alcohol to remove the betadine prep solution from the skin.
  • You will be told to follow ONE of the following instructions.
    • Leave the dressing on.
    • Remove dressing in 48 hours. Apply band aids to incision sites. Avoid direct water when showering. Dry thoroughly after showering and re-apply band aids. Avoid soaking in hot tubs, pools, lake or pond, as this increases the risk of post operative infection.

Questions/Concerns

Your surgeon should be contacted by calling 703-810-5202 Option 3, 24 hours a day for any of the following symptoms:

  • Fever greater than 101.5 degrees F.
  • Numbness, loss of good color or coolness in the arm.
  • Severe pain unresponsive to narcotic medication.
  • Excessive bleeding or vomiting.
  • Difficulty breathing or shortness of breath, CALL 911.

Follow-Up

You will have a post-operative appointment scheduled. If you need to verify or change your post-op appointment, please call 703-277-2663.

Post-operative instructions for lower extremity

Rest, Ice and Elevation

  • Remain generally at rest.
  • Elevate and apply ice to area for the first 48 hours.
  • Dressings must be kept dry.

Medication

You will be told which medications to take.

To minimize gastric upset from narcotics or anti-inflammatory medicine, eat adequate amounts of food.

Increase fluid and fiber intake to ease constipation from pain medication.

Dressing/Showering

  • Slight bleeding through the dressing/cast is common.
  • Dressings/cast must be kept dry.
  • Modify your bathing appropriately.
  • Cover your dressing/cast with plastic when bathing.
  • Use rubbing alcohol to remove the betadine prep solution from the skin.

Questions/Concerns

Your surgeon should be contacted by calling 703-810-5202 Option 3, 24 hours a day for any of the following symptoms:

  • Fever greater than 101.5 degrees F.
  • Numbness, loss of good color or coolness in the foot.
  • Severe pain unresponsive to narcotic medication.
  • Excessive bleeding or vomiting.
  • Difficulty breathing or shortness of breath, CALL 911.

Follow-Up

You will have a post-op appointment. If you need to verify or change your post-op appointment, please call 703-277-2663.

Post-operative instructions for total joint replacement

You will receive your customized post-op instructions after your surgery.

Report the following to your surgeon

  • Severe or worsening pain
  • Unusual or increasing drainage/bleeding
  • Increasing redness at the incision site
  • Fever greater than 101
  • Persistent nausea/vomiting
  • Signs of blood clots
    • Swelling or pain in calf/leg on either side
    • Chest pain
    • Shortness of breath
    • Rapid/unusual heart rate
    • Dizziness or confusion

Activity

  • Increase your activity a little every day.  Continue to do your exercises and use your walker, crutches or cane until your doctor tells you to stop.  It’s OK to go up and down stairs.
  • Change your position every hour while awake.  Remember to place a rolled towel under your ankles.
  • Eat your meals with your feet dangling down.  Sitting in a firm chair that has arms will be easier.
  • Go to your physical therapy appointments.  Your doctor will tell you when you are allowed to drive.

Wound care

  • Keep the waterproof dressing in place for 7 days then remove and change daily with 4×4 gauze or Primapore (bandaid type) dressing.
  • You may shower, but NO tub baths, whirlpools, pools or hot tubs.
  • Keep incision clean and dry.  Do Not apply any creams or ointments to incision area.

Compression stockings

  • Wear your stockings – this will reduce swelling and help to prevent blood clots.
  • You may remove the stockings twice a day for an hour.

Anticoagulation

  • Take your anticoagulant as directed by your physician.  (Lovenox, Coumadin, Xarelto or Aspirin)
  • If you are on Coumadin make sure to have your blood drawn as prescribed.  The dosage you take will depend on your blood results.
  • Continue until your doctor tells you to stop.
  • If you have problems with bleeding call you doctor.

Pain Medications

  • Take pain medication as needed.  You may take extra strength Tylenol (acetaminophen) for mild pain instead of your prescription medication.  (Do not exceed maximum daily dose of 3000 mg)
  • DO NOT TAKE non-steroidal anti-inflammatory products such as Baby Aspirin, Motrin, Aleve
  • Take pain medication 20-30 minutes prior to your physical therapy appointment.
  • REMEMBER – Narcotics can be constipating – drink plenty of fluids.  Stool softeners/laxatives may be used as needed.

Follow-up appointments

  • Call your surgeons office for an appointment (usually 14 days after surgery)
  • Implant ID card will be provided.